Exploring phenotypic patterns of cytokine storm in pediatric patients with severe viral infections and multisystem dysfunction: a case series illustrating successful novel therapeutic strategies

Abstract

Background: Cytokine storm syndrome (CSS) in pediatric patients with severe viral infections is a life-threatening hyper-inflammatory response leading to multi-organ dysfunction. Despite growing recognition, limited data exists on its clinical phenotype and therapeutic strategies in children. Objective: To describe the phenotypic features, diagnostic findings, and outcomes of pediatric patients with viral-induced CSS treated at a tertiary care hospital using advanced immunomodulatory therapies. Methods: We conducted a retrospective analysis of eleven previously healthy children admitted to Al Jalila Children’s Hospital from October 2022 to October 2024. Demographics, viral etiology, biomarkers, imaging, and treatment responses were evaluated. Results: Patients presented with systemic inflammation, respiratory distress, and frequent cardiovascular involvement. All patients received intravenous immunoglobulin; six required corticosteroids, and four received biologic agents including anakinra, tocilizumab, or ruxolitinib. All patients showed clinical resolution without long-term complications. Conclusion: Early identification of CSS and timely implementation of targeted immunomodulatory therapy in pediatric patients with severe viral infections may significantly improve outcomes. These findings highlight the need for diagnostic vigilance and a multidisciplinary treatment approach in managing pediatric CSS.